New AMA report shows 21 percent decrease in opioid prescriptions in Colorado, other physician-led advances
by CMS staff report
Featured in the July/August 2018 Colorado Medicine.
The American Medical Association issued a report May 31 documenting how physicians are advancing the fight against the opioid epidemic. It is based on a study by the IQVIA Institute for Human Data Science titled, “Medicine Use and Spending in the U.S.: A Review of 2017 and Outlook to 2022.” The Colorado Medical Society applauds all physicians making strides against this public health crisis through education and practice changes, and urges all physicians to work together on long-term solutions.
The report found a decrease in opioid prescribing, and increases in the use of state prescription drug monitoring programs (PDMPs), the number of physicians trained and certified to treat patients with an opioid use disorder, and in access to naloxone.
“While this progress report shows physician leadership and action to help reverse the epidemic, such progress is tempered by the fact that every day, more than 115 people in the United States die from an opioid-related overdose,” said Patrice A. Harris, MD, MA, chair, AMA Opioid Task Force. “What is needed now is a concerted effort to greatly expand access to high quality care for pain and for substance use disorders. Unless and until we do that, this epidemic will not end.”
“Over the last five years, Colorado physicians have consistently supported a range of voluntary and public policy initiatives aimed at reversing the public health crisis caused by opioid abuse and misuse,” said M. Robert Yakley, MD, CMS president. “The AMA report demonstrates these efforts are paying off. Combined with a legislative package developed by the Opioid and Other Substance Use Disorders Interim Study Committee and passed by the 2018 Colorado General Assembly, Colorado will continue to make gains in reversing the crisis and expanding access to care for an opioid-addicted patient cohort that knows no regional, gender, age, income or other boundaries.”
Fewer opioid prescriptions
Opioid prescribing has decreased for the fifth year in a row. Physicians have decreased opioid prescriptions nationwide for the fifth year in a row. Between 2013 and 2017, the number of opioid prescriptions decreased by more than 55 million – a 22.2 percent decrease nationally. Decreases occurred in every state, including a 21.1 percent decrease here in Colorado.
Increased PDMP use
PDMP registration and use continues to increase. In 2017, health care professionals nationwide accessed state databases more than 300.4 million times – a 121-percent increase from 2016. States with and without mandates to use the PDMP saw large increases. Nearly 40,000 physicians and other health care providers were registered with the PDMP in Colorado in 2016 and queries increased from 683,000 in 2014 to 1.5 million in 2016 (2017 numbers were not reported).
More physician education
Physicians are enhancing their education. In 2017, nearly 550,000 physicians and other health care professionals took continuing medical education classes and other education and training in pain management, substance use disorders and related areas. Many of these resources are offered by the AMA, state and specialty societies, and more than 350 of these resources can be found on the AMA opioid microsite, www.end-opioid-epidemic.org. A separate CMS all-member opioid survey released in November 2017 showed that nearly three-quarters (70 percent) of CMS physicians report taking CME regarding opioids in at least the past two to three years.
Access to naloxone is rising
Naloxone prescriptions more than doubled in 2017, from approximately 3,500 to 8,000 naloxone prescriptions dispensed weekly. So far in 2018, that upward trend has continued; as of April, 11,600 naloxone prescriptions are dispensed weekly – the highest rate on record.
Treatment capacity increasing
As of May this year, there were more than 50,000 physicians certified to provide buprenorphine in office for the treatment of opioid use disorders across all 50 states – a 42.4 percent increase in the past 12 months.
“We encourage policymakers to take a hard look at why patients continue to encounter barriers to accessing high quality care for pain and for substance use disorders,” Harris said. “This report underscores that while progress is being made in some areas, our patients need help to overcome barriers to multimodal, multidisciplinary pain care, including non-opioid pain care, as well as relief from harmful policies such as prior authorization and step therapy that delay and deny evidence-based care for opioid use disorder.”
More needs to be done
To further address the opioid epidemic, the AMA and CMS urge policymakers and insurers to remove barriers to care for pain and substance use disorders. These steps include the following.
- All public and private payers should ensure that their formularies include all FDA-approved forms of medication-assisted treatment (MAT) and remove administrative barriers to treatment, including prior authorization.
- Policymakers and regulators should increase oversight and enforcement of parity laws for mental health and substance use disorders to ensure patients receive the care that they need.
- All public and private payers – as well as pharmacy benefit management companies – must ensure that patients have access to affordable, non-opioid pain care.
- We can all help put an end to stigma. Patients with pain or substance use disorders deserve the same care and compassion as any other patient with a chronic medical condition.